The present invention relates to a method for the quantification of methylated cytosines in DNA. 5-methylcytosine is the most frequent covalent base modification in the DNA of eukaryotic cells. It plays an important biological role, e.g. in the regulation of the transcription, in genetic imprinting, and in tumorigenesis (for review: Millar et al.: Five not four: History and significance of the fifth base. In: The Epigenome, S. Beck and A. Olek (eds.), Wiley-VCH Verlag Weinheim 2003, p. 3-20). Therefore, the identification of 5-methylcytosine as a component of genetic information is of considerable interest. However, a detection of 5-methylcytosine is difficult because 5-methylcytosine has the same base pairing behaviour as cytosine. Therefore the usual methods for identifying nucleic acids are not applicable. Moreover, the epigenetic information carried by 5-methylcytosine is completely lost during PCR amplification.
The usual methods for methylation analysis operate essentially according to two different principles. In the first case, methylation-specific restriction enzymes are utilized, and in the second case, a selective chemical conversion of unmethylated cytosines to uracil is conducted (bisulfite treatment; for review: European Patent Application 103 47 400.5, filing date: Oct. 9, 2003, applicant: Epigenomics AG). In a second step the enzymatically or chemically pretreated DNA is amplified and analyzed in different ways (for review: Fraga and Esteller: DNA methylation: a profile of methods and applications. Biotechniques, 2002 September; 33(3):632, 634, 636-49; WO 02/072880 pp. 1 ff) . For sensitive detection the DNA is usually bisulfite treated and subsequently amplified by different Real Time PCR methods (“MethyLight”; for review: Trinh et al.: DNA methylation analysis by MethyLight technology. Methods. 2001 December; 25(4):456-62); WO00/70090; U.S. Pat. No. 6,331,393; Herman et al.: Methylation-specific PCR: a novel PCR assay for methylation status of CpG islands. Proc. Natl. Acad. Sci. USA. 1996 Sep 3; 93(18):9821-6; Cottrell et al.: A real-time PCR assay for DNA-methylation using methylation-specific blockers. Nucl. Acids. Res. 2004 32: e10).
A quantification of cytosine methylation is required for different applications, e.g. for classifications of tumors, for prognostic statements or for the prediction of drug effects. A particularly important application is the cancer diagnosis out of bodily fluids. Cancer cell DNA in bodily fluids has the property to be uniformly methylated over stretches of several 100 base pairs, while DNA of normal cells like blood shows a random mosaic methylation. However, a reliable diagnosis by detecting specially methylated cytosines in body fluids is difficult, because the aberrant methylation pattern has to be found within a large amount of background DNA, which is methylated differently, but which has the same base sequence. Therefore an optimal cancer test requires an exact quantification and a high specificity towards uniformly methylated DNA.
Several methods for quantification of methylation are known in the state of the art. These are usually based on a bisulfite treatment and a subsequent amplification. In most cases the analysis takes place after the amplification (e.g. Ms-SNuPE, hybridisation on microarrays, hybridisation in solution or direct bisulfite sequencing; for review: Fraga and Esteller 2002, loc. cit.). However, this “endpoint analysis” leads to several problems: due to product inhibition, enzyme instability and decrease of the reaction components the amplification does not proceed uniformly. Therefore a correlation between the amount of input DNA and the amount of amplificate does not always exist. As a consequence, the quantification is error-prone (for review: Kains: The PCR plateau phase—towards an understanding of its limitations. Biochem. Biophys. Acta 1494 (2000) 23-27).
The real time PCR based MethyLight technology uses a different approach for a quantification. This method analyses the exponential phase of the amplification instead of the endpoint. Traditionally a threshold cycle number (Ct) is calculated from the fluorescence signal that describes the exponential growth of the amplification (P S Bernard and C T Wittwer, Real-time PCR technology for cancer diagnostics, Clinical Chemistry 48, 2002). The Ct value is dependent on the starting amount of methylated DNA. By comparing the Ct value of an experimental sample with the Ct value of a standard curve the methylated DNA can be quantified (for review: Trinh et al. 2001, loc. cit.; Lehmann et al.: Quantitative assessment of promoter hypermethylation during breast cancer development. Am. J. Pathol. 2002 February; 160(2):605-12).
There are two commonly used methods to calculate the Ct value. The threshold method selects the cycle when the fluorescence signal exceeds the background fluorescence. The second derivative maximum method selects the cycle when the second derivative of the amplification curve has its maximum. For classical real-time PCR assays both methods produce identical results.
However, both methods do not produce exact results for the quantification of methylation via MethyLight assays. The MethyLight technology normally uses a methylation specific amplification (by methylation specific primers or blockers, sometimes methylation unspecific primers are used) combined with a methylation specific probe (for review: Trinh et al., 2001, loc. cit.). The methylation specific probe results in fluorescence signals from only a part of the generated amplificates depending on the methylation status of the CpG positions covered by the probe. This results in amplification curves that are downscaled compared to curves from completely methylated template DNA. These downscaled curves are the reason that both analysis methods generate incorrect results.
The threshold method assumes that all curves are in their exponential growth phase when exceeding the threshold. However, for samples with low proportions of DNA that is methylated at the probe (especially common in cancer diagnostics) this is not true. Amplification curves are already in the plateau phase and Ct estimation will be wrong.
The second derivative maximum method is independent from the overall intensity of the amplification curve. It only takes the shape into account which corresponds to a quantification of DNA that is methylated at the priming sites. The information generated by the methylation specific probe—represented by the signal intensity—is not used.
Here a new quantification method for uniformly methylated DNA is disclosed which leads to clearly improved results by combining both curve and intensity criteria. Due to the great importance of cytosine methylation and due to the above mentioned disadvantages in the prior art the present invention marks a significant technical progress.